Long-Term Plaque Psoriasis: Factors Influencing Clinician Decisions

Psoriasis is a chronic disease that affects 2% to 3% of men and women.2 The disease is characterized by plaques and reddish scaly patches. Some women develop pustular psoriasis, which can be life-threatening if severe.3 Although most women with psoriasis notice symptom improvement during pregnancy, 10% to 20% have symptom deterioration.3 The effect of psoriasis on fetal health is unclear.2 Some studies have suggested that psoriasis, which is a TH1-driven disease, contributes to lower birth weight as observed in other TH1-driven diseases.2 The proposed negative effects of psoriasis on fetal health are usually linked to moderate or severe psoriasis. Topical corticosteroids are safe to use during pregnancy, but topical tar products, tazarotene, and retinoids are teratogenic and should be avoided.2,7 Ultraviolent B phototherapy is safe in pregnant women with moderate to severe psoriasis but may compromise folate levels.2 Limited data are available about the safety of biologics during pregnancy, and careful consideration is required before prescribing.2,7
A novel study identifies significant clinical determinants affecting therapeutic choices in the treatment of long-term plaque psoriasis.

Clinical determinants affecting practitioner decision-making in the treatment of plaque psoriasis were identified in study data published in Annales de Dermatologie et de Vénéréologie.

Although there are well-established guidelines for the treatment of acute psoriasis plaques, the maintenance phase strategy is highly varied. To better understand how clinicians develop long-term treatment plans, investigators administered questionnaires to a sample of clinicians from France and Belgium. Practitioners were randomly selected according to their clinic location, such that geographical distribution was even across countries. Questionnaires presented a series of case vignettes and asked respondents which diagnostic and therapeutic decisions they would make for each patient scenerio. Logistic regression models were used to identify which factors influenced practitioners’ treatment decisions.

A total of 100 dermatologists were included in the study: 76 from France and 24 from Belgium. In addition, 86 general practitioners from France also completed the questionnaire. Most (66.7%) enrolled dermatologists were women and the majority (72.6%) of general practitioners were men.

Long-term treatment to prevent relapses was recommended by dermatologists in 79.1% of cases and general practitioners in 76.8% of cases. A topical fixed-dose combination of vitamin D analogue and a corticosteroid was recommended by French and Belgian dermatologists for 54.8% and 39.8% of cases, respectively. Among general practitioners, this recommendation was made for 14.8% of cases (odds ratio [OR], 1.9; 95% confidence interval [CI], 0.11-0.33; P <.001). Among dermatologists, the decision to initiate long-term maintenance treatment was significantly influenced by patient-reported quality of life. Specifically, dermatologists were more likely to prescribe long-term treatment in patients whose quality of life was highly impacted by skin lesions (OR, 2.0; 95% CI, 1.3-3.3; P =.03), it was noted. Among general practitioners, the likelihood of prescribing maintenance therapy was strongly increased with the presence of skin pruritus (OR, 1.8; 95% CI, 1.2-1.8; P =.004) and patient concerns about steroids (OR, 1.7; 95% CI, 1.1-2.7; P =.03).

Study limitations include the small cohort size; the researchers wrote that further research in a clinical setting is necessary to better understand long-term psoriasis treatment options.

Results from this study suggested to the researchers that the majority of dermatologists and general practitioners recommend long-term maintenance therapy in plaque psoriasis. However, reported reasons for recommending maintenance therapy differ by discipline.

“Our study is the first to identify significant clinical determinants affecting the therapeutic decision,” investigators wrote. “Updated and validated clinical practice guidelines are needed to ensure uniform therapeutic choices.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Quiles-Tsimaratos N, Paul C, De La Brassinne M, et al. Decision-making factors for the long-term topical treatment of mild-to-moderate plaque psoriasis: TEPPSO, a case-vignette study on clinical practice. Ann Dermatol Venereol. Published online July 1, 2022. doi:10.1016/j.annder.2022.05.003